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αρθροσκόπηση ώμου μτχ παρακολούθηση

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αρθροσκόπηση ώμου μτχ παρακολούθηση

  1. 1. Αρθροσκόπηση Ώμου και άμεση μετεγχειρητική παρακολούθηση Μάνος Αντωνογιαννάκης Διευθυντής Κέντρου Αρθροσκοπικής Χειρουργικής Ώμου ΙΑΣΩ General
  2. 2. The Shoulder  Greatest Range of Motion in the Body  Motion in all 3 planes of movement  Prone to injuries  8-20% of all sports injuries
  3. 3. History • 1931 First Cadaver Shoulder Arthroscopy Burman • 1974 First Shoulder Arthroscopy in vivo Johnson LL • 1982 First Arthroscopic repair Johnson LL of Shoulder Instability
  4. 4. Diagnostic arthroscopy The way everything began!!
  5. 5. Light General Anesthesia with Laryngeal Mask
  6. 6. Plus Local Anesthesia Scalene Block
  7. 7. Patient Positioning Padding bony prominences Beware of the neck
  8. 8. Room Set up Lateral decubitus allows easy access to the anterior and posterior part of the joint
  9. 9. Keep the operating room cold to avoid fogging but Keep the patient warm
  10. 10. Basic Arthroscopic Tools Have them all ready from the beginning
  11. 11. Cannulated Tools
  12. 12. Draping
  13. 13. Arm Draping Be careful with traction
  14. 14. Traction: NOT more than 4 Kgrs
  15. 15. Skin Marking
  16. 16. Before Entering the Scope Saline Backflow Saline in
  17. 17. Making the scope portal
  18. 18. 30º Scope Entrance
  19. 19. Diagnostic Arthroscopy • Distinguish Normal Anatomy • Anatomic Variants • Variation of GHLs • Sublaral Hole • Cord-like middle GHL • Buford Complex • Rotator Crescent Sign (cuff “ridge”) • SLAP lesions • Bursal side RC tears • Internal Impingement
  20. 20. Shoulder Arthroscopy the evolution of the technique Diagnostic Tool Final Treatment From tool of the devil the treatment of choice of most shoulder pathologies
  21. 21. Therapeutic Arthroscopy • Rotator Cuff disease • Tears (Full, Partial, Intratendonious) • Calcifying Tendonitis • Instability • Anterior, Posterior, Multidirectional • Bony Bankart lesions • Glenoid defects • HAGL and reverse HAGL lesions
  22. 22. Therapeutic Arthroscopy • SLAP lesions • Frozen Shoulder • AC joint • Arthritis • Dislocation • Biceps Pathology
  23. 23. Rotator Cuff Massive Tears
  24. 24. Rotator Cuff Massive Tears
  25. 25. Rotator Cuff Subscapularis Tear
  26. 26. Rotator Cuff Subscapularis Tear
  27. 27. Rotator Cuff Calcifying Tendonitis
  28. 28. Rotator Cuff Calcifying Tendonitis
  29. 29. Frozen Shoulder
  30. 30. AC Joint Distal Clavicle Excision
  31. 31. AC Joint Distal Clavicle Excision
  32. 32. AC Joint • Dislocation
  33. 33. Shoulder Instability
  34. 34. Arthroscopic success rate • Savoie 1997 93% • Burchart, De Bear 2000 96% • J Tauro 2000 93% • Kim 2003 96% • Snyder 2006 93% • Fabbriciani 2004 100%
  35. 35. Thank you

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